In order to be successful in that arena, Ms. Brady said ASCs need to change their systems of care. "It has to be modified and adapted," she said. She advised ASC leaders to focus on developing the following three components of the service line.

1. Infrastructure. This involves service line leaders and physician participation, according to Ms. Brady. "It begins with the right people," she said. "You're going to need a physician champion and a multidisciplinary team that will make sure you stick to protocols."

The infrastructure also includes patient selection to avoid complications, ensuring your facilities are equipped to perform the joint surgery, surgery scheduling and payer contracts.

2. Clinical program. Creating the clinical program will involve identifying the outpatient clinical pathway and a standardized plan of care. "We need to understand what that preferred plan of care is," Ms. Brady said.

ASCs also need to address service providers and partners and emergency protocols, as well as staff training. "Understand within your OR staff: Have they done total joint replacement? And if not, how are they going to get that kind of training?" she said.

Patient education, such as teaching people to use a walker, is also very important in order to avoid adverse events such as falls. "We need to front load that and be sure that happens religiously for these patients and families," Ms. Brady said.

3. Management. Some ASC leaders may get overly eager after the infrastructure and clinical program stages, but it's crucial not to skip the management element, which involves collecting outcomes and marketing, according to Ms. Brady.

Collecting outcomes data and identifying trends can help the ASC make the program better. "If you get your outcomes going, it will improve the program, and likewise, the program will improve your metrics," she said.

It's also important to promote the program through marketing through word-of-mouth and media outlets such as the Web, radio and TV. "You really need to create a niche for yourself to let the community know you're a provider in that space."

Lastly, ASCs need to focus on program sustainability. "Critique yourself evaluate how last week went, and make changes," she said. "You don't want to do all that work of defining protocols and patient selection criteria and then not have anybody follow it. That's going to set your program up for failure."